Demystifying Medicine One Week at a Time

Mr. Fonzarelli (not his real name), a 60s-ish patient of mine was recently hospitalized after a routine colonscopy.

Apparently he’d flipped his heart rhythm into something called atrial fibrillation, where the top two chambers of the heart beat asynchronously and chaotically at a rapid pace (in his case, >400 beats per minute).

Here’s what he wrote me about his overnight stay in the hospital [bolding mine]:

I didn’t want to be admitted, and it totally blew my plans out of the water. Psychologically I felt as if I had been ambushed and abused even though the cardiologists followed their best professional judgment. Multiple diagnostic tests, lots of blood draws, etc. Even an echocardiogram, both conventional and the new one in 3D. I saw the inside of my heart in 3D, and it was so good that even I could tell what I was looking at.

By my estimate, in less than 24 hours in the hospital Mr. Fonzarelli had at least three separate blood draws [stay tuned for a future post on the bloodbath that is modern medicine]. As unpleasant as his experience was, he appreciated being able to see his own heart in motion on the 3D echo. He writes on:

Hospitalization was an absolutely horrible experience, because on the one hand I arrived completely unprepared for the stay with not even anything to read, and because I had a roommate who snored and fell asleep with both the lights and his TV on, and because and there was nothing to do but wait for hours on end for the next thing to happen. After the echocardiogram they just left me parked outside the imaging room, and I had to just lie there for 40 minutes until the transfer guy came. The cardiologists, who were mainly preoccupied with the new 3D system, were sympathetic, but I commented to them that one difference between GlassHospital and [FamousClinic] is that Famous runs on time.

You can imagine how for a literate man like Mr. Fonzarelli being trapped without reading material amounts to a form of torture. To someone like him, the endless daytime prattle of Jerry Springer (is he still on?), Oprah, or the now-near-ubiquitous Dr. Oz on the never-off hospital televisions amounts to its own assault. Of course, you’ll note that he was in a 2-bed room, which are still the norm in many public hospitals, but are being phased out in many privates, including GlassHospital.

I was anxious to get discharged; it took four hours to execute the discharge process and paperwork… I think there was too much work for existing personnel. It seemed to suggest why so many people from the neighborhood go to Fancy Hospital [downtown] for care.

Four hours to be discharged. Hmmmm. How long are people in the ER waiting for these hospital beds upstairs?

I was not in any pain while I was there, and the people I dealt with at every rank were unfailingly kind and capable, but the experience was the worst 24 hours I have ever put in largely because being trapped in boredom is an affliction that begins to rival physical agony. I was made to just wait for hours on end. Maybe the fact that the system at GlassHospital seems to foster boredom as a default is the result of how many of its patients seem to be conditioned to accepting boredom and waiting in line and it becomes standard operating procedure…

It does sound a lot like standard operating procedure at hospitals that I’m familiar with. It’s not this way by design, of course, but by evolution and the processes of entropy. With all of the compliance and documentation requirements placed on modern caregivers and hospitals, it may not be surprising that honoring a patient’s time moves down the priority list. Maybe Mr. Fonzarelli is on to something with his comment about there being “…too much work for existing personnel.”

I wonder though: Is it too much work for us, or not enough concern on our part with his priorities?

His conclusion:

If I have another episode of atrial fibrillation, which I probably won’t, I don’t even know what to do about it, and the ER is the last place I would want to go.

I love that a patient like Mr. Fonzarelli takes the time to write to me in such a forthright fashion. And I think he’s right on the mark.

I only wish I had better answers for him about the state of our art and science.

3 Comments

Having experienced similar circumstances on several occasions in hospitals both in Ohio and Florida, I commend you for pointing out the weaknesses of hospital systems in your experience. I applaud the objectivity in your written comments and hope that hospital administrators everywhere will recognize the extreme frustration that patients suffer from frequent and seemingly redundant blood draws, temperature taking, blood pressure checks and general disturbances while in their care.

My last hospitalizations (in 1997 and 2001) were at a hospital that both times put me in a four-person room. (And this was in what is considered the fancier hospital in Cambridge MA.) It was an absolute nightmare. At least in a two-person room, the chances are the other person will be asleep some of the time (though one still has to make sure the tv gets turned off, since some people seem to leave the tv on while they fall asleep) but in a four-person room the odds are really high that at any particular point at least one of the other people is awake and making noise.

I hope eventually hospital managers catch on that people are NOT GOING TO RECOVER IF THEY CAN’T SLEEP.

I can deal with waiting and boredom, but I can’t deal with the noise that one is exposed to in most hospitals. All those monitors sounding, the televisions, the pagers, etc. Unspeakable.